Posts Tagged statin drugs

If you are debating whether or not to fill that prescription for a statin medication, you may want to read this article first.

I remember when I was learning to …

According to the research, damage was present in greater than half of those who reported myopathy (muscle pain).

Dr. Ray’s Notes:
Muscle pain and weakness is a common side effect of statin medications and should be taken seriously. Although severe muscle damage is rare, it appears that a mild-moderate muscle injury is much more common and can persist for years after stopping the statin medication. To decrease the risk of muscle damage associated with statins, I recommend that those who take statin medication take 100 mg of Ubiquinol twice daily. Ubiquinol is an activated form of coenzyme Q10 and may be better absorbed and utilized. It is also recommended that those who take statins also supplement with a potent multi-vitamin and fish oil.

The simple answer to this question is yes, however, the deeper more philosophical answer would be “yes, in the same way that the Atlantic Ocean level drops when one person gets out of it.” The better question is how much does the risk really drop when you take a statin drug. The results may surprise you.

In order to understand how the medical industry misleads you and your doctor into believing that these medications actually make a significant difference to your health, you will need to understand some very basic statistic terms. I realize that this may make you want to stop reading, but please continue, I promise that they are very easy to grasp and will only require 60 seconds of your time. Here they are:

Relative Risk (RR) – This is almost always the number that will be reported by the press and the drug companies because it makes the tiniest of difference sound quite impressive. Relative risk is best described by giving an example. If a study is looking to find out if a medication decreases the risk of death in a giving period and the results demonstrate that the medication decreased the death rate from 4 per 1000 to 2 per thousand then the Relative Risk reduction is 50%. It sounds quite impressive that a medication decreased the risk of death by 50%.
Absolute Risk (AR) – This number is the more meaningful of the two statistical numbers and will almost never be presented to the public unless they are discussing the side effect risk. An example of absolute risk reduction can be demonstrated by the above example. If the medication decreases the risk of death from 4 per 1000 patients to 2 per 1000 patients then the absolute risk reduction is a measly 0.2%. As you can see, this number is not as impressive as a 50% reduction.
Number Needed to Treat (NNT) – This value is an interesting representation of the data and can be quite useful in evaluating the significance of risk reduction. This value basically tells you how many people need to take the medication before one benefit is realized. If death is the endpoint, NNT means how many people you will need to give the medication to before one life is saved.
Now that you have a fundamental understanding of basic statistics, let us evaluate some of the research literature. Please note, we are not choosing obscure studies in order to prove our point, we are evaluating the very same studies presented by the drug companies and published in peer reviewed journals.

EXCEL Study – The EXCEL study used lovastatin and was a short duration of only 1 year. Unfortunately for the drug company, there was an increased relative risk of death of 150% and an absolute increased risk of 0.3%. This means that the lovastatin increased the risk of death. The NNT for this study was 333 which means that you had to treat 333 people to kill one person.
AFCAPS Study – Again lovastatin was the medication used in the study. This time the study continued for 5.2 years and again resulted in an increased risk of death, although lower than the previous study. RR was a 3.9% increased risk of death, 0.09% increased absolute risk and you would need to treat 5000 people with lovastatin to kill one person.
4S Study – This study used simvastatin and followed people for 5.4 years. At study’s end the subjects who took the simvastatin apparently enjoyed a 29% decreased relative risk. The absolute risk reduction was a miniscule 3.3% decrease which means you will need to treat 167 people in order to save one life.
HPS Study – This study used simvastatin and followed subjects for 5 years. At the study’s end the simvastatin group had a 12% relative risk reduction which translates to an absolute risk reduction of 1.8% which means you will have to treat 278 people in order to save one life.
WOSCOPS Study – This study used pravastatin and followed people for 4.4 years. In this study there was a 22% decreased relative risk reduction which amounted to less than a 1% absolute risk reduction. This means that you will need to treat 500 people in order to save one life.
PROSPER Study – This study used pravastatin for 3 years and had a relative risk reduction just under 2% which was an absolute reduction of just 0.2%. This means that in order to save 1 life 1429 people would need to be treated.
ASCOT Study – This study used medicines most powerful statin, atorvastatin. The relative risk reduction was just 12% after 3 years and the absolute risk reduction was just 0.15%. This means that you will have to give 667 people to save one life.

As you can see, it is in the advantage of the drug company to report the relative risk which is an inflated statistical value that is not the actual or absolute risk. When absolute risk is taken into account, the medication still appears to lower risk of death it is just a lot less than the relative risk would have you believe. In my book I am only interested in the absolute number of deaths, this way I can make a truly informed decision about my course of action. I am not interested in using a medication that only helps 1 in 300 people and subjects the remaining people to needless side effects such as liver damage, nerve damage, memory loss, muscle pain and increased cancer risk.

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By blocking this enzyme, the medication decreases the body’s internal production of cholesterol. Unfortunately, a well known and fairly common side effect is muscle pain and weakness that can often be debilitating. In addition to blocking the production of cholesterol, it is well known that these medications also block the production of important nutrients such as coenzyme Q10. We have known that a deficiency of coenzyme Q10 can lead to muscle pain and that supplementation can help to reverse this side effect. A recent study sheds light on another nutrient that is closely linked to muscle pain, vitamin D. We have known that vitamin D deficiency can cause both pain and weakness in the muscles, however, research had not linked vitamin D deficiency to muscle pain induced by cholesterol lowering medications…until now.

In a study of 621 patients who were prescribed statin medications, it was found that those who suffered with the muscle pain were significantly deficient in vitamin D. When the patients who suffered with muscle pain were supplemented with vitamin D, 92% of the patients saw resolution of their pain symptoms.
(Transl Res, 2009; 153(1): 11-6)

Dr. Ray’s Notes:

We have always known about statin’s impact on coenzyme Q10 levels and we commonly recommend coenzyme Q10 supplementation in those who take a statin medication. This study, may explain why some people continue to have pain even after supplementation with high doses of coenzyme Q10 and I am now beginning to recommend vitamin D supplementation for those who are taking statins. This makes perfect sense given the fact that your body produces vitamin D from, you guessed it, cholesterol. When cholesterol drops, it makes good sense that vitamin D levels may drop as well. In this study, the participants were placed on the prescription vitamin D at a dose of 50,000 iu weekly. I would recommend using a natural form of vitamin D on a daily basis rather than a synthetic form in high dose once weekly. For the general population I recommend 2,000 iu daily. If your blood is significantly deficient, you may require higher doses. Have your doctor order a blood test for 25-OH vitamin D with your next cholesterol test and to learn more about vitamin D, read our article 15 Facts You Must Know About Vitamin D.

Osteoporosis is a disease where bones become fragile and more likely to break. It is important to understand that bones are not lifeless structures, but instead are complex living tissue.

Just like our skin, bones are constantly broken down and built back up with new, healthy, pliable bone. Two cells involved in bone maintenance are osteoblasts and osteoclasts. The osteoblasts are the “bone builders.” In contrast, the osteoclasts are the cells responsible for the breakdown of old, brittle bone. The ratio of these two types of bone cells must be in balance to maintain strong and healthy bones.

Due to the Standard American Lifestyle your bones break down faster than new bones can be formed. In women, bone deterioration accelerates after menopause due to the fact that the ovaries stop producing estrogen, a hormone that protects against bone loss.

Your blood is a tightly controlled system that requires biochemical finesse in order to make an optimal environment for your cells and organs to function. Blood pH is of critical importance, if your blood gets even slightly acidic then the critical enzymes would not function and death would occur. In order to maintain proper pH the body utilizes minerals to act as a buffering system. So how does your blood get acidic? The answer is food and stress. When you eat lots of animal protein, refined carbohydrates like bread, pasta, white rice and sugar these things add acid to your body.

When you eat vegetables and low-sugar fruits you neutralize some of that acid. The problem is you need 5 times as much alkaline food to neutralize 1 part of acid food. Stress also will cause excessive acid to form in the body. So what does this have to do with your bones?

The bones are your body’s mineral bank account. If you aren’t giving it plenty of those green leafy vegetables then your body will have to choose, between death or osteoporosis. In this case, your body becomes like Robin Hood, it steals from the mineral rich bones and gives to the mineral poor blood and organs.

To maintain bone health we should make sure that the bones have all of the necessary mineral building blocks. These building blocks feed the osteoblasts so as to keep new and healthy bone developing over your life. A readily absorbed bone mineral formula such as Osteo Plus will accomplish this. I would also suggest an additional 2,000-4,000 iu of vitamin D during the Spring and Summer and 4,000-6,000 iu during the winter months.

On top of this, adding a green drink full of concentrated green vegetables and superfoods will help keep your body alkaline by providing phytochemicals and organic minerals that neutralize acid.

To treat osteoporosis the standard procedure has been to take drugs such as Fosamax to inhibit bone deterioration and to increase intake of calcium. In the short term this approach may provide benefit to bone strength and fracture risk. There is concern, however,  of the long term ramifications of such an approach. This approach may result in poor quality bone and thus could lead to increased risk of fractures years later. To avoid this, our goal is to increase bone formation and normalize bone deterioration.

We suggest that calcium, magnesium, boron, proteins, and other trace minerals be taken to help increase bone formation. The average diet consists of 600 mg of calcium so most people should only supplement with another 600-800 mg of calcium daily. There are many different types of calcium available, however not all of them are efficient forms. Calcium carbonate, found in Oscal, Tums, and their popular little brother Viactive, is considered the worst form of calcium. This form does not absorb due to its buffering effect in the stomach. Calcium carbonate needs an acidic environment of the stomach in order to dissolve.

Some good forms of calcium are calcium citrate, calcium citrate-malate, calcium MCHA, and calcium lactate. We suggest that magnesium be taken in a 2:1 or 1:1 ratio of calcium to magnesium. Daily, 2,000-5,000 units of Vitamin D can be taken.

An intake of 3-6 mg of boron a day is recommended.

Vitamin K stimulates new bone growth. Vitamin K1 can be obtained by eating vegetables, however, this form has not been effective at improving bone density.  Vitamin K2, produced through fermentation of K1, increases bone growth and normalizes bone deterioration.

Trace minerals can be found in many good bone-mineral formulas.

All these suggested supplements are primarily the elemental building blocks of bone formation. The body needs a stimulus for the bone formation. This stimulus is in the form of weight bearing and resistance exercise. Walking is just not enough because it does not put enough stress on the bones, the best exercise is weight lifting. In order to promote bone growth you will need to stress the bones that are in need of growth. In other words, you can’t rely on a bicep curl to make the hip bone stronger. Placing weight on the shoulders and doing squats may be a better option.

If you suffer from osteoporosis, you may need to do this under the supervision of a physical therapist. You may also want to purchase a weighted vest to wear while walking. This may help add more stress to the bones to stimulate their growth. If you suffer from osteoporosis, you may want to purchase walking poles, which are ski poles that have been built for walking. This helps to stabilize your gait and increase the number of calories you burn. Be sure to check with your doctor.

If you have weak bones, such as with osteopenia or osteoporosis, here are the suggestions for building healthy bones:

1. Progena’s OsteoPlus – This is a comprehensive bone mineral formula that provides you with the calcium, magnesium, boron and other trace minerals in their best absorbed and utilized forms. 4 tablets daily taken in two divided doses.

2. Vitamin D - Vitamin D helps the body absorb and utilize the minerals. We suggest 1 capsule daily in addition to the vitamin D in your multi and bone mineral formula. We shoot for 2,000 – 5,000 IU on a daily basis, especially during the winter months.

4. Vitamin K – 15 – 45 mg daily. Vitamin K supplements is especially important in those that do not eat a lot of green leafy vegetables. If you have mildly unhealthy bones you may want to use Super K by Life Extension Foundation. If you have moderate to severely compromised bone health, you may want to try Ultra K2 (1 cap three times daily).

What to do to prevent bone loss:

1. OsteoPlus – 2 tabs in A.M. 2 tab in P.M.
2. Vitamin D 2,000 IU – 1 Softgel in the A.M.
3. Doctor’s for Nutrition Greens First – 1 scoop once or twice daily

Standard Program for Mildly unhealthy bones  (Osteopenia/Mild Osteoporosis):

1. OsteoPlus – 2 tabs in A.M. 2 tab in P.M.
2. Vitamin D and K with Iodine – 1 capsule in the A.M.
3. Doctor’s for Nutrition Greens First – 1 scoop once or twice daily

Aggressive program for moderate to severely unhealthy bones:

1. Bone Guard Forte by Perque – 3 tabs in A.M. 2 tabs in P.M.
2. Vitamin D 5,000 iu – 1 capsule in the A.M
3. Complementary Prescriotions Ultra K2 – 1 capsule three times daily
4. Doctor’s for Nutrition Greens First – 1 scoop once or twice daily